Advocate Report Back Form

 
Thank you for taking action!

As an advocate, you have done the hard work - now, let us know how it went! We will use the information you provide in our follow-up interactions with you and your legislators.
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1. Please provide your name:
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2. Today's Date
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3. Congressperson:
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4. State:
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5. Date action was taken:
MM DD YYYY
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6. How did you take action? (please select one)
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7. Was the action in response to an ACHA Advocacy Alert?
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